AAP Urges Compassion and Appropriate Care for Immigrant and Refugee Children

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​​In a newly released policy statement, the Academy urges that immigrant and refugee children be treated with dignity and respect, with care that supports their health and wellbeing.

Amid turmoil caused by new federal executive orders targeting immigrants and refugees and calling for vast expansions to the detention of immigrants, the American Academy of Pediatrics (AAP) has called for the U.S. government to protect vulnerable children who are fleeing violence and poverty from being traumatized.

Immigrant chil​dren seeking safe haven in the United States should never be placed in detention facilities, regardless of whether they arrive alone or are accompanied by an adult, according to a new policy statement published by the AAP. Children should never be separated from their families, according to the statement.

The policy statement recommends that immigrant children be treated with dignity and respect, and urges that they not be exposed to conditions that may further harm or traumatize them. The statement, "Detention of Immigrant Children," to be published in the April 2017 issue of Pediatrics (online March 13) reports that the Department of Homeland Security facilities for temporary housing of immigrants do not meet basic standards regarding the care of children in residential settings.

"Many of the immigrant children arriving to this country from our southern border are victims of unspeakable violence, persecution, and abject poverty," said Fernando Stein, MD, FAAP, president of the AAP. "From the moment they are placed in U.S. custody, they deserve a warm, safe and nurturing environment. They should receive health care that meets basic standards."

The AAP policy statement, "Detention of Immigrant Children," is being published at a time of increased fear, anxiety, and uncertainty among immigrant families. The AAP opposes the recent call for major expansions in family detention, among other actions, that have been included in Executive Orders signed by President Trump.

"We are hearing reports about children who have been detained, even for a short time, who are showing symptoms of post-traumatic stress disorder, anxiety, depression and behavioral problems," said Marsha Griffin, MD, FAAP, co-author of the policy statement and co-chair of the AAP Immigrant Health Special Interest Group. "There is no evidence that spending any time in detention is safe for children. Parents, too, may be traumatized by the isolating conditions, making it difficult for them to respond to their children's needs."

An estimated 95% of the children approaching the southern U.S. border emigrated from the Central American countries of Guatemala, Honduras, and El Salvador, which are plagued with extreme violence and poverty as well as a lack of state protection for at-risk children and families. In 2016, a total of 59,692 unaccompanied children and 77,674 families sought asylum at the border, according to U.S. government statistics.

The families undergo an immigration process that, depending on their circumstances, may result in immediate deportation, detention, or transportation to family residential shelters scattered across the country that provide dormitory-style shelter. Some immigrants are released to the community with ankle monitors, even though many immigrants may qualify for protected status in the U.S. because they are fleeing severe abuse, trafficking, and persecution.

Children are sometimes separated from a parent or other family members during the process.

The AAP recommends that families never be separated, and that children never be housed in detention centers. Last week, the Academy issued a press stateme​nt opposing a DHS proposal that would separate immigrant mothers from their children when they arrive at the U.S. border. More than 75% of families held in family residential shelters have proved they have a "credible fear" or "reasonable fear" of returning to their homeland, which grants them the right to seek refuge in the United States.

"It is not illegal to come to our border and seek protection," said Alan Shapiro, MD, FAAP, co-author of the policy statement. "These families are fleeing violence and they are asking for asylum. They should be viewed as asylum seekers, not undocumented or illegal immigrants. We should treat them humanely and compassionately."

In its policy statement, the Academy recommends:

That all immigrant children and families be treated with dignity and respect

That children not be exposed to conditions or settings that may re-traumatize them, such as those that currently exist in detention

That children never be separated from a parent or primary caregiver, unless there are concerns for the safety of the child at the hand of the parent

That when in custody, children be provided with child-friendly orientation and regular updates on their status, expectations and rights

That DHS should discontinue the use of family detention and instead use community-based alternatives.

That children receive timely, comprehensive medical care that is culturally and linguistically sensitive by trained medical providers, throughout the immigration processing pathway.

Studies of detained immigrants have shown that children and parents may suffer negative physical and emotional symptoms from detention, including anxiety, depression and posttraumatic stress disorder. When children live in fear for prolonged periods of time, they may develop toxic stress, which causes harm to the developing brain and can result in short and long-term health consequences.

"We know that children can overcome stress when they feel safe and have enduring, supportive relationships with caregivers," said Julie Linton, MD, FAAP, chair of the AAP Immigrant Child Health Special Interest Group, and a co-author of the policy statement. "All children deserve to be healthy and safe."

Editor's Note: The AAP has released a statement In response to the Revised Immigrant and Refugee Travel Ban Executive Order that was signed by President Trump Monday. The AAP announced its concern about how the ban will harm immigrant and refugee children, as well as international medical professionals in the statement: http://ow.ly/EGcn309Ed9d.